Monitoring glaucoma progression.
Monitoring progression is fundamental in managing patients with chronic open-angle glaucoma, which is as important as an early diagnosis of the disease. It is essential that both structural and functional damage be considered, in order to assure a complete and reliable assessment of progression. The optic disc and retinal nerve fiber layer damage can be evaluated using either low-tech (slit lamp biomicroscopy with a 78-diopter lens) or high-tech (HRT, OCT, GDx) methods; the latter providing a more objective and standardized analysis. The current gold standard in detecting functional damage is using standard automated perimetry (SAP). Different approaches can be used to assess SAP progression: (1) clinical judgment; (2) defect classification systems; (3) trend analysis; and, (4) event analysis. Several statistical programs are currently available to assist the ophthalmologist in the difficult task of assessing progression. Clinically relevant progression should only be considered when the change--be it structural and/or functional--is statistically significant, reproducible, and indicative of glaucomatous damage.
Brusini
Paolo
P
Department of Ophthalmology, Santa Maria della Misericordia Hospital, Udine (Italy), Piazzale S. Maria della Misericordia, 15 33100 Udine, Italy. brusini@libero.it
D018450:Disease Progression; D005902:Glaucoma, Open-Angle / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D009898:Optic Disk / Q000473:pathology; D012165:Retinal Ganglion Cells / Q000473:pathology; D014054:Tomography; D058609:Visual Field Tests / Q000379:methods; D014794:Visual Fields / Q000502:physiology